Medicaid Provider Screening Accountability Act: Policy, Social Determinants, and Evidence-Based Support

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Week 7 discussion

To Prepare:

• Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.
• Review the health policy you identified and reflect on the background and development of this health policy.

 

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Which social determinant most affects this policy? Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

Medicaid Provider Screening Accountability Act.(I chose this one)

• Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.
  • Chapter 4, “Policy Analysis and Design” (pp. 77–93)
  • Chapter 9, “The Influence of Patient Health Data on Health Policy” (pp. 197–217)
  • Chapter 10, “Financing Health Care” (pp. 247–257 only)
• American Nurses Association (ANA). (n.d.). Advocacy Links to an external site.. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy
• Congress.govLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/
• Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementationLinks to an external site.. Academy of Management Review, 21 (4), 1055–1080.
• Office of Policy, Performance, and Evaluation. (2019). The CDC policy processLinks to an external site.. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/policyprocess/index.html
• Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patientLinks to an external site.. Journal of Evaluation in Clinical Practice, 21 (6), 1014–1017.
• Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretionLinks to an external site.. Public Management Review, 16 (4), 527–547.

 

Struggling with where to start this discussion? Follow this guide to tackle it easily!

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Step-by-Step Guide for Your Week 7 Discussion Post

Step 1: Review the Policy

• Go to Congress.gov and search for the Medicaid Provider Screening Accountability Act.

• Read the summary, text, and any related updates to understand its purpose.

• Take notes on:

  • Why the policy was proposed

  • Which population it impacts

  • Screening and accountability requirements for Medicaid providers

Step 2: Describe the Policy and Background

• Provide a concise description of the policy. Example:
  “The Medicaid Provider Screening Accountability Act proposes enhanced screening and verification procedures for Medicaid providers to reduce fraud and ensure quality care. The policy aims to protect vulnerable populations and improve accountability across state Medicaid programs.”

• Explain the problem it addresses: fraud, abuse, or inappropriate billing in Medicaid, and how that impacts patient care.

Step 3: Identify the Social Determinant

• Determine which social determinant of health is most relevant. Examples:

  • Economic Stability: Medicaid recipients often face financial barriers to care.

  • Access to Health Care: Screening ensures that providers are qualified and accessible.

• Explain why this determinant is critical for the policy. Example:
  “Economic stability is the primary determinant affecting this policy because the policy protects low-income individuals who rely on Medicaid, ensuring that taxpayer funds are used appropriately and that patients have access to safe, qualified providers.”

Step 4: Assess the Evidence Base

• Identify studies, reports, or data supporting the policy:

  • Fraud and abuse statistics in Medicaid programs

  • Outcomes from prior provider screening initiatives

  • Research demonstrating the importance of provider accountability for patient safety

• Example statement:
  “Evidence supports enhanced provider screening. According to the CDC Policy Process (2019), policies that enforce provider verification reduce fraud and improve health outcomes. For example, states that implemented stricter provider screening experienced a measurable decrease in improper Medicaid payments.”

Step 5: Provide Specific Examples

• Include recent numerical or statistical evidence:

  • Percentages of Medicaid fraud cases detected

  • Impact on patient access or quality of care

• Include a citation from Milstead (2022) or other provided resources:

  • Milstead, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Step 6: Draft Your Discussion Post

• Begin with a brief introduction: describe the policy and why it matters.

• Include body paragraphs:

  • Policy description and background

  • Social determinant and its impact

  • Evidence supporting the policy

• Conclude with your reflection on the policy’s potential effectiveness.

Step 7: Cite Sources Properly (APA)

• Include in-text citations for Milstead (2022), CDC (2019), and any other references.

• Include a reference list at the end if required by your discussion format.

Step 8: Review and Submit

• Proofread for clarity, grammar, and APA formatting.

• Ensure your post is concise but detailed, typically 250–400 words for discussion boards.

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Suggested References from Your Resources:

• Milstead, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

• Office of Policy, Performance, and Evaluation. (2019). The CDC policy process. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/policyprocess/index.html

• American Nurses Association (ANA). (n.d.). Advocacy. https://www.nursingworld.org/practice-policy/advocacy

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